2025 ISAKOS Biennial Congress Paper
Exogenous Fibrin Clot Augmentation Of A Meniscus Horizontal Cleavage Tear Repair Increases The Radiological Healing Rates And Improves Functional Outcomes At One Year : A Prospective Comparative Study.
Dinshaw Pardiwala, MS(Orth), DNB(Orth), FCPS, Mumbai, Maharashtra INDIA
Raghavendraswami Vitthal Thete, DNB, Mumbai, Maharashtra INDIA
Ravikant H Jadhav, DNB orthopaedics, D. Ortho, Latur, maharashtra INDIA
Ankit Vilaschandra Amin, MS,DNB INDIA
Arzan Jamshed Jesia, MS Orthopaedics, DNB Orthopaedics , Mumbai, Maharashtra INDIA
Clevio Joao Baptista Desouza, MD, Mumbai, Maharashtra INDIA
Rammohan Birappa Yedave, DNB orthopedics , MBBS, Mumbai, Maharashtra INDIA
Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, INDIA
FDA Status Cleared
Summary
Although clinical, functional, and MRI assessment of meniscus healing at one year has limitations, whenever repair of degenerative and avascular regions of meniscus is indicated, there is benefit in augmenting the repair with an exogenous fibrin clot.
Abstract
Aims: The chondroprotective function of the meniscus is well recognised and consequently meniscus tears are treated with repair rather than resection whenever feasible. Although repair of acute traumatic tears results in predictable success, achieving healing in all types of meniscus tears is a challenge. The reason for poor healing rates in complex, chronic, and degenerative tears, is often not a deficiency of structural fixation, but an innate absence of healing potential, often termed as ‘inadequate biology’. Although numerous adjuvants have been proposed to induce ‘biology’ and promote a healing response in meniscus repair, there is limited evidence that any of these are effective. Animal studies have demonstrated that an exogenous fibrin clot can induce healing in an avascular meniscal zone by promoting the proliferation of fibrous connective tissue that eventually transforms into fibrocartilaginous tissue. However, exogenous fibrin clot augmentation has not gained popularity due to the lack of convincing evidence of clinical benefit. The purpose of this prospective comparative study was to determine whether an exogenous fibrin clot enhances healing following repair of horizontal cleavage tears (HCT) of meniscus. HCT were specifically chosen since these tears are usually degenerative in origin and occur largely in avascular zones of the meniscus.
Methods
44 patients with symptomatic isolated HCT of either meniscus, who had failed a minimum 4 months of a non-operative trial, underwent arthroscopic HCT repair of either the medial or lateral meniscus using circumferential compression sutures. Patients were radomised into two groups. Group A (22 patients)(age 37.9 ± 10.01 years) underwent HCT repair without fibrin clot augmentation. Group B (22 patients)(age 33.7 ± 7.1 years) underwent HCT repair with exogenous fibrin clot augmentation. Both groups underwent an identical rehabilitation program. Preoperative and postoperative Lysholm scores, IKDC subjective scores, and KOOS were determined. Barrett’s criteria for objective clinical evaluation of meniscal healing following meniscus repair were compared. MRI was performed 12 months following surgery to determine radiological healing following meniscus HCT repair and was assessed by two blinded MSK radiologists.
Results
Both groups had significant postoperative improvement in functional outcomes and Barrett’s criteria as compared to preoperative. Group B had significantly better postoperative Lysholm, IKDC, and KOOS scores are compared to Group A (p < 0.005). There was no significant difference in the postoperative Barrett’s criteria between Groups A and B. MRI in group A revealed complete healing in 27% with incomplete healing in 73% patients, whereas group B revealed complete healing in 50% with incomplete healing in 50% patients. No patient had any complications or underwent repeat surgery within the study period.
Conclusion
Exogenous fibrin clot augmentation of a meniscus horizontal cleavage tear circumferential compression suture repair improves functional outcomes (Lysholm, IKDC, and KOOS) and significantly increases the radiological healing rates when assessed one year following surgery. Although clinical, functional, and MRI assessment of meniscus healing at one year has limitations, whenever repair of degenerative and avascular regions of meniscus is indicated, there is benefit in augmenting the repair with an exogenous fibrin clot.